| NPI | 1851962468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024187757) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA rn658112) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN658112) | |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2023-08-16 |